EP3182995B1 - Medikament und vorrichtung zur behandlung von chronischer nierenkrankheit - Google Patents

Medikament und vorrichtung zur behandlung von chronischer nierenkrankheit Download PDF

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EP3182995B1
EP3182995B1 EP15756875.9A EP15756875A EP3182995B1 EP 3182995 B1 EP3182995 B1 EP 3182995B1 EP 15756875 A EP15756875 A EP 15756875A EP 3182995 B1 EP3182995 B1 EP 3182995B1
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bsp
blood
calcium
plasma
calcification
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Franz Paul Armbruster
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Immundiagnostik AG
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration
    • A61M1/3472—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration with treatment of the filtrate
    • A61M1/3486—Biological, chemical treatment, e.g. chemical precipitation; treatment by absorbents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration
    • A61M1/3496—Plasmapheresis; Leucopheresis; Lymphopheresis
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00—Drugs for disorders of the urinary system
    • A61P13/12—Drugs for disorders of the urinary system of the kidneys
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/24—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against cytokines, lymphokines or interferons
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
    • G01N33/6893—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids related to diseases not provided for elsewhere
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
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    • C07—ORGANIC CHEMISTRY
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    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
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    • C07K2317/00—Immunoglobulins specific features
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    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
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    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
    • G—PHYSICS
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    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/46—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans from vertebrates
    • G01N2333/47—Assays involving proteins of known structure or function as defined in the subgroups
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/32—Cardiovascular disorders
    • G01N2800/323—Arteriosclerosis, Stenosis
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/34—Genitourinary disorders
    • G01N2800/347—Renal failures; Glomerular diseases; Tubulointerstitial diseases, e.g. nephritic syndrome, glomerulonephritis; Renovascular diseases, e.g. renal artery occlusion, nephropathy

Definitions

  • the present invention relates to a medicament, apparatus and method for treating chronic kidney disease.
  • CKD chronic kidney disease
  • CPD chronic renal disease
  • CKD chronic kidney disease
  • GFR glomerular filtration rate
  • CKD chronic myelogenous kinase
  • a permanent kidney failure then requires a renal replacement therapy which may be a form of dialysis or a kidney transplant.
  • CKD progresses and GFR declines, mineral metabolism disturbances increase and hyperphosphatemia occurs along with a reduction in renal 1a-hydroxylation of 25-hydroxyvitamin D and low circulating levels of calcitriol which in turn cause a decrease of intestinal calcium absorption.
  • the disturbed calcium and phosphate homeostasis causes variable degrees of hypocalcaemia and secondary hyperparathyroidism, with concomitant abnormalities in bone turnover and metabolic bone disease.
  • the mineral and bone disorder is a common manifestation of CKD.
  • Other symptoms of CKD include increase blood pressure, iron deficiency anaemia, metabolic acidosis, azotemia and uraemia, an activation of the sympathetic tone, inflammation and oxidative stress.
  • CDK goes therefore in line with high morbidity and mortality.
  • CKD patients suffer in particular from accelerated atherosclerosis and tissue calcification.
  • CKD patients on dialysis or with end stage renal disease (ESRD) are more likely to die from cardiovascular complications than from kidney failure ( Kettler M et al, Nephrology 2009, 14: 389-394 ).
  • the progress of arterial and vascular calcification is linked to a dysregulated mineral metabolism and altered levels of serum calcium and calcium-phosphorus products.
  • the elevated extracellular levels of these minerals further affect the survival and phenotype of vascular smooth muscle cells and myocardial cells.
  • the calcification mostly as calcium hydroxyl apatite deposits, may occur in blood vessels, the myocardium and cardiac valves. In the arterial vessel wall, calcification takes place in the intima or in the media.
  • Medial calcification also referred to as Monckeberg sclerosis
  • Monckeberg sclerosis is the form classically associated with age, diabetes and CKD.
  • Conventional therapeutic approaches are usually directed to bringing the biochemical parameters to ranges associated with lower mortality. They comprise (a) a use of an adapted dialysate calcium concentration; (b) a use of phosphate-binding agents; (c) the administration of calcitriol or vitamin D analogues; (d) the use of calcimimetics; (d) diet recommendations (reducing dietary phosphate intake and administering phosphate binders and calcium supplements); and/or (e) the uptake of native vitamin D supplements.
  • WO 2011/000086 A1 (University of Alberta) discloses an method and apparatus for reducing serum phosphate levels and calcium product in patients by hemodialysis since observational data suggest that higher doses of calcium-based phosphate binders may contribute to vascular calcification. There is generally a considerable interest in controlling serum phosphate while minimizing oral calcium load. On the other hand, most phosphate is intracellular and thus unavailable to hemodialysis.
  • WO 2011/130528 A (Fresenius Medical Care Holdings Inc., US) discloses an extracorporeal blood treatment system including a calcium trap wherein an immobilized species is adapted to reduce the calcium concentration in the blood to a concentration that prevents blood clotting thereby producing calcium-depleted blood.
  • the object of the invention is achieved by a medicament for use in treating renally impaired patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) comprising an effective amount of a monoclonal antibody specifically binding to human bone-sialoprotein (BSP) in blood, plasma or serum, whereby extracellular tissue and vascular calcification, atherosclerosis, arteriosclerosis, and arterial calcification are prevented or reduced and the overall outcome of said patients is improved.
  • the medicament may be a human monoclonal antibody or a humanized monoclonal antibody or a rat monoclonal antibody Functional or essential portion means in this connection portion of the molecule which takes part in the detection and binding of human BSP in plasma. Not comprised are therefore linker portions, leader sequences which are cut off during protein maturation, or interchangeable portions of the antibody.
  • tissue and vascular calcification shall encompass the cardiovascular risks concomitant CKD, ESRD and renal replacement therapy and also comprise the terms arteriosclerosis and atherosclerosis.
  • CKD is generally associated with increased risk of coronary heart disease the knowledge with respect to the histopathologic characteristics of coronary atherosclerosis in individuals with CKD is scarce and the terms arteriosclerosis and atherosclerosis, while intrinsically relating to different etiologies, often used interchangeably.
  • the frequencies of advanced atherosclerotic lesion due to arterial calcifications is increasing with a concomitant decrease of the GTR.
  • Another aspect of the invention relates to an extracorporeal blood treatment system
  • an extracorporeal blood treatment system comprising means for withdrawing blood from a patient; means for separating blood cells and plasma; means for transporting the plasma through a trap for soluble BSP, the BSP trap including a substrate having an immobilized species able to bind soluble BSP, wherein said species is a monoclonal antibody specifically binding to human bone-sialoprotein (BSP) in blood, plasma or serum being adapted to reduce the soluble BSP concentration in the blood to a concentration that prevents vascular and tissue calcification, thereby producing BSP-depleted plasma; and means for returning treated plasma and blood cells back to the patient.
  • BSP bone-sialoprotein
  • the extracorporeal blood treatment system may further comprise means for transporting the blood and/or plasma through a calcium trap, the calcium trap including a substrate having an immobilized species, the species being adapted to reduce the calcium concentration in the blood to a concentration that prevents formation of a precipitate of calcium and BSP in the extracorporeal blood treatment system, thereby producing calcium-depleted blood; means for treating the calcium-depleted blood or plasma downstream of the calcium trap by an extracorpareal plasma treatment device, which may also comprise a trap for bone sialoprotein; and means for infusing calcium into the treated calcium-depleted blood downstream of the extracorporeal blood treatment device to add calcium to the treated calcium-depleted blood.
  • a calcium trap including a substrate having an immobilized species, the species being adapted to reduce the calcium concentration in the blood to a concentration that prevents formation of a precipitate of calcium and BSP in the extracorporeal blood treatment system, thereby producing calcium-depleted blood
  • said species able to bind soluble BSP is a monoclonal antibody specifically binding to human bone-sialoprotein (BSP) in blood, plasma or serum which is bound to or contained in any solid phase material selected from beads, agarose, material used for apheresis, material used for plasmapheresis, microtiter plate, vessel wall.
  • BSP bone-sialoprotein
  • the present invention provides a novel therapy concept based on a removal of circulation BSP (bone sialoprotein) from the plasma of patients with chronic kidney disease (CKD), preferably by plasmapheresis or an administration of antibodies against BSP in plasma.
  • BSP bone sialoprotein
  • the present invention further provides a BSP absorber material for plasmapheresis and a pharmaceutical composition for direct administration which are biocompatible in humans.
  • the beneficial effects of this therapy have been proven by the observed correspondence between levels of circulating free BSP levels and mortality of CKD patients.
  • vascular smooth muscle cells vascular smooth muscle cells
  • the first step appears to be a de-differentiation or transformation of vascular smooth muscle cells (VSMC) into an osteoblast/chondrocytic phenotype.
  • VSMCs originate from a similar mesenchymal stem cell as osteoblasts. It is believed that transcription factor core binding factor a1 (Cbfa-1; encoded by the RUNX2 gene) is responsible for the phenotypic transformation of VSMCs to osteoblast cells.
  • the signals that induce a transformation to an osteoblast/chondrocytic phenotype are multiple.
  • Calcification occurs if there is an imbalance between inhibitors of calcification and pro-mineralizing factors that stimulate VSMC de-differentiation.
  • Bone sialoprotein a phosphorylated glycoprotein
  • BSP bone sialoprotein
  • RGD recognition sequence
  • BSP forms in vitro crystallization nuclei for biological apatite and in vivo it takes part in mineralization. The switching off of the BSP gene in knock-out mice leads however to no recognizable disruption of the building and functioning of the skeleton.
  • BSP is involved in tissue calcification as its binding to collagen is needed to initiate bone mineralization and the adhesion of osteoblasts to the mineralized matrix ( Ogata Y, J. Periodontal Res. 2008, 43(2): 127-135 ).
  • WO 00/36919 discloses a suppression of the expression of BSP in tumor and connective tissue cells which promote calcification.
  • In vitro studies suggest that BSP is involved in the transformation from VSMC to osteoblast-like cells and that a pharmacologically reduced expression of BSP may lead to a deceleration of this transformation process.
  • BSP knockout mice only show a reduction in bone turnover, with a reduced recruitment of osteoclasts. Mice over-expressing BSP have an elevated bone turnover as evidenced by elevated calcium and reduced PTH levels. There is however no clinical or other evidence that an elimination of BSP from plasma may cause osteoporosis.
  • Postmenopausal woman suffering from osteoporosis show elevated levels of serum BSP compared to perimenopausal healthy controls.
  • Treatment with alendronic acid® (INN) as well as hormone replacement therapy, both established treatment options of osteoporosis, lead to a reduction of serum BSP levels in postmenopausal women.
  • Calcified lesions contain osteoblasts, osteoclasts, trabeculae and numerous proteins regulating calcification such as osteopontin, alkaline phosphatase and bone sialoprotein. More precisely, we have discovered an immunostaining for BSP and other pro-mineralizing proteins regulating calcification prior overt calcification in the arteries of ESRD patients. This has lead us to the assumption that a deposition of BSP precedes calcification so that it could be target for specific inhibition of tissue and arterial calcification. As BSP has such a central role in the calcification progress we initiated experiments on whether vascular and soft tissue calcification is reduced and the overall outcome of renally impaired patients with CKD or ESRD is improved by interfering with this protein using therapeutic antibodies.
  • BSP may be removed from circulation using plasmapheresis.
  • Our new therapeutic approach aims at reducing uremic vascular and soft tissue calcification and improving overall outcome of CKD by modulating the concentrations of circulating BSP in plasma. This may be achieved by the development of a plasmapheresis intervention that eliminates excess BSP from the circulation in a hemodialysis process.
  • the 5/6 nephrectomy (5/6 Nx) of rats is most used for studies of progressive renal disease. This is because the features of this experimental procedure are common to CKD observed in humans [ Kren S et al, The course of the remnant kidney model in mice. Kidney Int. 1999; 56:333-337 ].
  • the 5/6 nephrectomy has also been established to test new therapies and has been proven to be clinically relevant [ Fujihara CK et al, Losartan-hydrochlorothiazide association promotes lasting blood pressure normalization and completely arrests long-term renal injury in the 5/6 ablation model. Am J Physiol Renal Physiol.
  • the 5/6 nephrectomy can be performed by unilateral nephrectomy and either partial infarction or amputation of the poles of the remaining kidney [ Santos LS et al, Surgical reduction of the renal mass in rats: morphologic and functional analysis on the remnant kidney. Acta Cir Bras. 2006;21:252-257 ].
  • mice Male Wistar rats weighing about 100 g were used for all experiments. They were subjected to a 5/6 nephrectomy by two surgeries within two weeks. One week after the first surgery, the kidney remnant rats were further fed a diet comprising 1.2% phosphate and 0.9% calcium to induce tissue and vascular calcification. One week after the second surgery the animals further received oral doses of calcitriol of 0.25 mg/kg which suppresses parathyroid hormone production. The calcitriol administration further promotes vascular calcifications by several mechanisms: (i) an increase in intestinal calcium and phosphate absorption; (ii) over-suppression of parathyroid hormone resulting in low bone turnover disease and diminished calcium delivery to the bone; and (iii) direct effects on the vascular wall.
  • Aortic medial calcification can be reduced vis-ci-vis untreated controls by a 10 systemic treatment with the matrix metalloproteinase inhibitor such as doxycycline ( Qin X et al, Matrix metalloproteinase inhibition attenuates aortic calcification. ArteriosclerThromb Vase Biol 2006; 26: 1510-1516 ).
  • the matrix metalloproteinase inhibitor such as doxycycline
  • the rat blood pressures were measured non-invasively first time three days after the first treatment with anti-BSP mAb by determining the tail blood volume with a sensor and an occlusion tail cuff.
  • the treatments by anti-BSP mAbs were repeated in weakly intervals using low, medium, and high doses, respectively.
  • tail blood was taken and the animals 20 killed by a use of isoflurane gas.
  • the organs were taken for further histological analyses: von Kossa staining for quantifying mineralization and calcification in tissue sections; Sinus Red staining (connective tissue staining) for quantifying interstitial and perivascular fibrosis; Elastica van Gieson staining (connective tissue staining solution) for determining the media to lumen ratio in cardiac 25 and renal vessels; PAS diastase staining for determining glomerulosclerosis; by wet chemistry for the presence of calcium and phosphate products; by Western blotting for collagen I, collagen II, TGF- ⁇ 1, SMAD-2, CTGF; and by RT-PCR forTRP5, P21, VDR, MMP2, MMP9, osteopontin, ANP, TRPV6, calbindin, BSP, CBFA1, osterix, osteocalcin.
  • Measured blood plasma parameters creatinine, calcium, phosphate, magnesium, fetuin A, FGF-23, beta2-microglobulin; calbindin, clusterin, cystatin-C, NGAL, osteopontin, TIMP-1, VEGF.
  • the organs were taken at end and visually inspected.
  • the aortas from healthy (sham) animals showed no signs of aortic calcification, no atherosclerotic intima lesions and no 'artheriosclerotic' intima/media lesions.
  • the aortas from 5/6 Nx kidney remnant rats, which had received a phosphorus calcium diet and calcitriol, showed massive aortic calcifications and dilated aorta brackets.
  • the thoracic and abdominal regions of the aortas of the Nx rats further showed dilated calcified brackets.
  • healthy (sham) animals showed no symptoms for a kidney disease
  • the remnant kidneys of the 5/6 Nx rats were edematous enlarged and whitely colored as typical for uremic calcification.
  • the body weight of healthy (sham) and 5/6 Nx rats were significantly different after five weeks.
  • the body weights of the healthy animals increased gradually during the five weeks period whereas the body weights of placebo-treated 5/6 Nx rats increased at the beginning and decreased with progressing calcification treatment.
  • the body weights of anti-BSP mAb treated 5/6 Nx rats increased during the entire period of five weeks so that the body weights of anti-BSP-mAb treated animals were significantly higher than for untreated animals.
  • the plasma level of cystatin C is a parameter reflecting the glomerular filtration rate (GFR) and kidney function.
  • Fig. 2 is a column diagram comparing the plasma cystatin C levels for 5/6 Nx rats which had received an anti-BSP-mAb therapy (pooled for low, medium and high dose therapy) and 5/6 Nx rats which received a treatment with a placebo.
  • the Mann-Whitney U test (MWU) of the data supports significantly lower cystatin C values for 5/6Nx animals (pooled) which had received an anti-BSP mAb therapy compared to untreated 5/6 Nx controls (***p ⁇ 0,0001).
  • the kidney were histologically examined after staining. No large differences could be detected after the von Kossa staining for calcium products.
  • the Sirius Red staining showed a trend to reduced interstitial fibrosis, and the PAS staining a significantly reduced glomerulosclerosis (see Fig. 4 ) and media to lumen ratio ( Fig. 3 A / B ) for 5/6 Nx rats which had received an anti-BSP therapy.
  • 5/6 Nx rats subjected to an anti-BSP mAb therapy had significantly less glomerulosclerosis compared to untreated 5/6 Nx controls (***p ⁇ 0,0001; *p ⁇ 0,05); anti-BSP treated 5/6 Nx rats also showed a significantly reduced media to lumen ratio compared to untreated controls at intrarenal vessels as well as a reduced perivascular fibrosis.
  • 5/6 Nx rat subjected to an anti-BSP mAb therapy showed a trend to a lowered expression of the matrix protein collagen I and collagen III ( Fig. 5 ) when analyzed by Western blot analysis, compared to placebo treated rats and sham. The standard deviation of the results however was high so that the result is only significant for collagen III.
  • the RT-PCR expression analysis for renal vitamin D receptor shows that the anti-BSP mAb therapy seems to bring about an up-regulation of the vitamin D receptor compared to placebo-treated 5/6 Nx rats and sham (see Fig. 4 ).
  • the wet chemical analysis of the renal calcium phosphorus product produced no significant differences.
  • the histological examination of the heart showed a significantly reduced interstitial fibrosis for 5/6 Nx rats ( Fig. 6 ) receiving an anti-BSP IDK1 mAb therapy.
  • the therapy also reduced cardiac perivascular fibrosis significantly (see Fig. 7 ).
  • the results were significant compared to placebo-treated controls and sham (*p ⁇ 0,0001; *p ⁇ 0,05).
  • Fig. 8 While the total aortic calcification ( Fig. 8 ) did not differ significantly in the aortas the wet chemical analyses showed a significantly reduced amount of phosphorous deposits.
  • the RT-PCR analyses further support a reduced expression of the metalloprotease MMP9 ( Fig. 9 ) compared to placebo-treated 5/6 Nx rats.
  • the results support that an administration of an antibody binding to a non-precipitated or soluble form of bone sialoprotein in plasma has a significant effect on tissue and vascular calcification in the chosen animal model for CKD.
  • Von Kossa staining of aorta sections showed that extensive aortic calcifications were present in calcitriol-treated uremic rats.
  • no calcifications were observed in sham animals and the anti-BSP antibody treatment was able to decrease calcification.
  • Anti-BSP-antibody treated animals also had a significantly decreased media-to-lumen ratio of intrarenal vessels and less perivascular fibrosis of intrarenal vessels.
  • BSP is bound in plasma by complement factor H with high affinity.
  • complement factor H There have been produced antibodies against peptide partial structures of BSP ( Fisher, L.W. et al., Acta Orthop Scand Suppl., 1995, 266, 61-655 ), against recombinant BSP ( Stubbs JT 3rd et al. J. Bone Miner. Res. 1997 12(8), 1210-22 ), and against BSP isolated from bones, which antibodies failed to bind any BSP in plasma or serum.
  • As the larger factor H molecule of 150 kDa seems to mask the smaller BSP of ca. 65 kDa ( Fedarko NS et al., J. Biol.
  • Chem., 200, 275, 16666-16672 ; WO 00/062065 we screened for an antibody which cross-reacts with BSP (rat or human) in serum or plasma, or a BSP fragment thereof, and this even in the presence of factor H or endogenous BSP receptors.
  • rat monoclonal antibody (anti-BSP_IDK1)
  • a partial proprietary humanized antibody library comprising humanized variants of the rat complementary determining region which binds to human BSP in plasma with high affinity.
  • a chimeric CDR-grafted human monoclonal antibody was obtained.
  • the underlined portion stands for the signal peptide (with an intron removed) and the portion in bold (underdotted) comprises the CDR.
  • the underlined portion represents the signal peptide.
  • An intron has been removed for the translation in the signal peptide of the heavy chain.
  • the portion in bold is the constant CH1-hinge-CH2-CH3 region of the antibody.
  • the underlined portion represents the signal peptide.
  • the portion in bold represents the constant CH1-hinge-CH2-CH3 region of the antibody.
  • the peptides used for screening the monoclonal rat antibodies for binding to human BSP in plasma were modified with beta-alanine for increasing affinity or peptides with multiple copies of a BSP epitope were used.
  • a human monoclonal antibody in our proprietary human antibody phagemid library which was then made fully human using recombinant technology ( Stefan Dübel, edt., Handbook of Therapeutic Antibodies, Wiley-VCH 2010; ISBN 978-5-527-32902-1 ).
  • Suitable stationary immunosorbent materials are commercially available, e.g. GLOBAFFIN® and Immunosorba® (Fresenius Medical Care AG, DE).
  • the therapeutic method for removal of the circulating BSP would require that the blood of the patient is first separated into blood cells and blood plasma using a machine.
  • the plasma containing the BSP is passed extracorporally through one of more immunosorbent columns. The columns contain the monoclonal antibody against circulating BSP.
  • the second Whilst the first column is loaded with BSP the second is rinsed (regenerated), to become available again for a further loading cycle. After removal of the circulating BSP, the plasma is mixed again with the blood cells and returned to the patient.
  • Such an extracorporeal treatment of the blood usually takes between three and five hours and can be done using for example the Octo-Nova® machine (Diamedtechnik GmbH, GmbH, DE).
  • the efficacy and biocompatibility (safety) of the BSP adsorbent material will be proven in an ex vivo study, and finally a tolerability apheresis study phase will be conducted to prove human safety, and reduction of BSP following apheresis in CKD patients.
  • the test antibody (anti-BSP IDK2) was coupled to the stationary phase (Sephadex®) using the NHS method which proved more effective than coupling by BrCN.
  • the coupling was done using a solution of the antibody at 1 mg/ml at 4 degrees Celsius with an NHS-activated column material in borate buffer (BBS, pH 10.0).
  • BBS borate buffer
  • the BSP material could be desorbed again from our test columns using a mixture of citrate and vitamin C at a pH of 2.8 to 4.
  • the binding capacity and kinetics only decreased from 85% to 73% in the course of eight rounds of apheresis which is acceptable for these initial tests.
  • the binding kinetics proved equally acceptable (see Fig. 12 )
  • the optimal parameters for an immunosorbent column material is beaded cross-linked NHS-activated agarose as this gives a reusable and safe column material.
  • the coupling is preferably done in an alkaline carbonate or borate buffer at 4 to 8 degrees Celsius.
  • the binding temperature was optimal at 30 degrees Celsius and about 75 ml blood could be purified from BSP using 15 ml column material.

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Claims (5)

  1. Medikament zur Verwendung bei der Behandlung von renal beeinträchtigten Patienten mit chronischer Nierenerkrankung (CKD) oder terminaler Nierenerkrankung (ESRD), enthaltend eine wirksame Menge eines monoklonalen Antikörpers, der humanes Bone-Sialoprotein (BSP) in Blut, Plasma oder Serum spezifisch bindet, so dass extrazelluläre Gewebe- und Gefäßverkalkung, Atherosklerose, Arteriosklerose und arterielle Verkalkung verhindert oder reduziert ist, und das Gesamtergebnis der Patienten besser ist.
  2. Medikament zur Verwendung gemäß Anspruch 1, wobei der monoklonale Antikörper ein humaner monoklonaler Antikörper oder ein humanisierter monoklonaler Antikörper oder ein monoklonaler Rattenantikörper ist.
  3. Extrakorporales Blutbehandlungssystem, umfassend:
    Mittel zum Ausleiten von Blut aus einem Patienten;
    Mittel zum Trennen von Blutzellen und Plasma;
    Mittel zum Transport des Plasmas durch eine Falle für lösliches BSP, die BSP-Falle aufweisend ein Substrat mit einer immobilisierten Substanz, die lösliches BSP zu binden vermag, wobei die Substanz ein monoklonaler Antikörper ist, der humanes Knochen-Sialoprotein (BSP) in Blut, Plasma oder Serum spezifisch bindet und der ausgelegt ist, die Konzentration von löslichem BSP im Blut auf eine Konzentration zu reduzieren, bei der die Gefäß- und Gewebeverkalkung von renal beeinträchtigten Patienten mit chronischer Nierenerkrankung (CKD) oder terminaler Nierenerkrankung (ESRD) reduziert ist, so dass man BSP-abgereichertes Plasma erhält; und
    Mittel zur Rückführung von behandeltem Plasma und Blutzellen in den Patienten.
  4. Extrakorporales Blutbehandlungssystem gemäß Anspruch 3, ferner umfassend Mittel zum Transport von Blut und/oder Plasma durch eine Kalziumfalle, aufweisend ein Substrat mit einer immobilisierten Substanz, die die Kalziumkonzentration im Blut auf eine Konzentration zu reduzieren vermag, welche die Bildung von Niederschlag aus Kalzium und BSP im extrakorporalen Blutbehandlungssystem reduziert, so dass man Kalzium-abgereichertes Blut erhält;
    Mittel zur Behandlung von Kalzium-abgereicherten Blut oder Plasma stromab der Kalziumfalle durch eine extrakorporale Plasmabehandlungsvorrichtung, die auch eine Falle für Bone-Sialoprotein umfassen kann; und
    Mittel zur Infusion von Kalzium in das behandelte, Kalzium-abgereicherte Blut stromab der extrakorporalen Blutbehandlungsvorrichtung, um Kalzium in das behandelte Kalzium-abgereicherte Blut hinzuzufügen.
  5. Extrakorporales Blutbehandlungssystem gemäß Anspruch 3, wobei die Substanz ein monoklonaler Antikörper ist, der menschliches Bone-Sialoprotein (BSP) im Blut, Plasma oder Serum spezifisch bindet, und der an einer festen Phase gebunden ist oder enthalten ist in einem Material, ausgewählt aus Beads, Agarose, Material für die Apherese, Material für die Plasmapherese, Mikrotiterplatte, Gefäßwand.
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